How to Create an Advance Directive in Washington State

To create an advance directive in Washington State, you complete two separate documents: a health care directive (the living will) under RCW 70.122, which tells doctors what treatment you want at the end of life, and a durable power of attorney for health care under RCW 11.125, which names a person to make medical decisions when you cannot.¹² Each document must be signed and either notarized or witnessed by two qualified people. Most people complete both, because one alone leaves gaps the other fills.

Why You Need Both Documents

The two documents come from different statutes and do different work. The health care directive applies only when two physicians certify that you have a terminal condition or are permanently unconscious. It says nothing about serious but recoverable illnesses. The durable power of attorney for health care names an agent to make broader decisions whenever you lack capacity, not just at the end of life.³

Sign only the directive and you have written wishes but no one authorized to speak for you in a broader crisis. Sign only the power of attorney and your agent has authority but no written guidance about what you actually want. Together they give clinicians a clear picture and your agent a roadmap.

What Goes in the Health Care Directive

The directive records what you want done if you are diagnosed with a terminal condition (an incurable, irreversible illness where treatment would only prolong dying) or are permanently unconscious (an irreversible coma or persistent vegetative state).¹ Two physicians must confirm the diagnosis before the directive takes effect.

The core choices are whether to withhold or withdraw life-sustaining treatment, and whether you want artificially provided nutrition and hydration. The statutory form asks you to check a box specifically on nutrition and hydration, so think that one through before signing. The statute says the form “may” follow the statutory template, which means you can add specific instructions about mechanical ventilation, CPR, or other treatments you feel strongly about.

The Pregnancy Clause

The default statutory form contains language that invalidates the directive during pregnancy.¹ Because the template is permissive rather than mandatory, you can modify or remove that provision. If you are or may become pregnant, look at this section carefully and consider talking to an attorney about how you want it worded.

Choosing Your Health Care Agent

Your agent has authority to make any health care decision you could make, provided the power of attorney expressly grants that authority.² Pick someone who understands your values, can hold their ground against relatives who may disagree, and is realistically reachable on short notice. Name at least one alternate in case your first choice is unavailable. Write down full legal names and current phone numbers for both.

Who Cannot Serve

Washington bars your physicians, their employees, and the owners, administrators, or employees of the health care or long-term care facility where you receive care or reside from acting as your agent. The exception is family: if that person is also your spouse, registered domestic partner, parent, adult child, or sibling, they can serve.² So a daughter who happens to be a nurse at your hospital is still eligible; an unrelated doctor at the same facility is not.

Signing the Documents

Both documents need your signature and either notarization or two qualified witnesses. You do not need both methods for either document.

Health Care Directive

Have your signature acknowledged before a notary public, or sign in the presence of two qualified witnesses.¹ Either makes the document legally valid. Notarization is often faster if you can find a notary nearby.

Durable Power of Attorney for Health Care

The power of attorney must be signed and dated by you, with your signature either acknowledged before a notary or attested by two or more competent witnesses.⁴ Notarization creates a legal presumption that the signature is genuine, which helps if anyone later challenges the document.

Notary Fees

Washington caps notary fees at $15 per notarial act in person and $25 for remote notarization.⁵ Many banks and some public libraries notarize for free.

Who Can Witness

The two documents have different witness rules. Both sets of restrictions exist to keep people with a stake in your medical or financial outcome out of the signing process.

For the health care directive, a witness cannot be:

Related to you by blood or marriage
Entitled to inherit any portion of your estate under your will or by operation of law
Your attending physician or an employee of that physician
An employee of the health care facility where you are a patient
Anyone with a financial claim against your estate at the time of signing¹

For the durable power of attorney, a witness cannot be a home care provider for you, a care provider at an adult family home or long-term care facility where you reside, or related to you or your agent by blood, marriage, or state registered domestic partnership.⁴ Neighbors, coworkers, or friends with no family or financial connection to you are usually safe choices for either document.

What an Advance Directive Will Not Do at the Scene

An advance directive sits in a medical record or a filing cabinet. It is not something paramedics can act on at your home. EMTs are required to stabilize you and transport you to a hospital, and only a physician there can implement your directive.

The tool for out-of-hospital wishes is a POLST (Portable Orders for Life-Sustaining Treatment). A POLST is a medical order signed by a physician that travels with you and is honored by emergency personnel on the spot, covering resuscitation, medical interventions, antibiotics, and artificial feeding.⁶ If you have a serious illness and want your wishes followed before you reach a hospital, ask your doctor about completing a POLST in addition to your advance directive.

Storing and Distributing Copies

A properly signed directive is useless if no one can find it. Give copies to your agent, your alternate agent, your primary care physician, and any specialists you see regularly so the documents make it into your electronic medical record. Bring a copy to any hospital admission.

Keep an original at home somewhere your family knows about, such as a bedside drawer or an accessible home safe. Some people carry a wallet card that notes the directive exists and lists the agent’s phone number. Digital storage services can make documents available to clinical teams at the point of care, but do not rely on a digital copy alone.

Revoking or Replacing the Directive

You can revoke your health care directive at any time, regardless of your mental state. Washington provides three methods:⁷

Physical destruction. You, or someone at your direction, burns, tears, shreds, or otherwise defaces the document.
Written revocation. You sign and date a written statement expressing your intent to revoke.
Verbal revocation. You state your intent to revoke in the presence of a witness who is at least 18, and that witness signs and dates a writing confirming what you said.

After revoking, notify your agent, alternate, and every provider who has a copy. Outdated instructions in a medical record create dangerous confusion in an emergency. To replace rather than simply cancel a directive, complete and distribute the new one at the same time you revoke the old one.

When Your Agent Can See Your Medical Records

Naming someone as your agent does not automatically give them access to your records today. Under HIPAA, the person named in a health care power of attorney is a “personal representative” only when the document is currently in effect.⁸ Some powers of attorney take effect immediately on signing; others only take effect when you lose capacity. If yours is the latter kind, your agent has no right to your records while you still have capacity. If you want your agent to be able to review records and speak with your doctors now, either draft the power of attorney to take effect immediately or sign a separate HIPAA authorization.

Mental Health Situations Need a Separate Document

Washington maintains a separate statute, Chapter 71.32 RCW, for mental health advance directives.⁹ A mental health advance directive lets you name an agent for mental health treatment decisions and record your preferences about inpatient admission, electroconvulsive therapy, and psychotropic medications. Only a person with capacity can execute one.

This matters because the standard health care power of attorney under RCW 11.125 is subject to the same limits as a guardian when it comes to consenting to inpatient admission or electroconvulsive therapy, unless you have separately consented through a mental health advance directive.² If you have a psychiatric condition that may affect your future decision-making, the mental health directive is the document that covers those decisions.

1
Washington State Legislature. Revised Code of Washington 70.122.030
2
Washington State Legislature. RCW 11.125.400 – Agent Authority Health Care
3
Washington State Office of the Attorney General. Living Wills
4
wa-law.org. Revised Code of Washington 11.125 – Uniform Power of Attorney Act
5
Washington State Legislature. WAC 308-30-220
6
Washington State Department of Health. Portable Orders for Life Sustaining Treatment (POLST)
7
Washington State Legislature. Revised Code of Washington Chapter 70.122 – Natural Death Act
8
U.S. Department of Health & Human Services. Does Having a Health Care Power of Attorney Allow Access to the Patient’s Medical and Mental Health Records Under HIPAA?
9
Washington State Legislature. Revised Code of Washington Chapter 71.32 – Mental Health Advance Directives